. >> good afternoon, everybody welcome to the san francisco budget & finance committee for wednesday, may 13, 2015, i want to thank the members of sfgovtv jonathan and jim smith mime mark farrell i'll be chairing this committee i'm joined by supervisor kim and supervisor yee and commissioner eric mar and supervisor avalos i want to thank clerk linda wong madam clerk, any announcements? questions madam chair questions madam chair please be advised the ringing of and use of cell phones, pagers and similar sound-producing electronic devices are prohibited at this meeting. are prohibited at this meeting. use of a cell phone, pager, or other similar sound-producing electronic devices. item one the staffing levels avoidance at the san francisco

general in relationship to the affordable health care act and the opening of san francisco general and requesting the duplicate to report. >> thank you madam clerk supervisor avalos. >> thank you supervisor farrell and colleagues for hearing this having this hearing in the biscuit thank you to the members of the public and the department of public health and the human services department to put together the presentation this hearing is kind of like the second part of a hearing i'll called last year about the cannabis conditions of san francisco general and the concerns the length of time to hire people especially nurses within the department of public health over at the judgemental hospital we want to get a progress report how things have

moved tin last year last june a plan that was shared going to reduce the time it took to bring nurses on to work in the department of public health especially the san francisco general but we have to make sure that we're prechg the work necessary to open the new hospital and be on track with the hiring with the new hospital making sure they bring the maximum benefit that we would have a with the affordable health care being implemented here in san francisco i wanted to thank barbara hale the did you want director for her work preparing for this hearing i did a little bit work i actually went a second time last year, i not to the san francisco general and this year to the san francisco general and got a sense of the concern from the

workers and various rapid quick half an hour but to the emergency department and some of the clinics adjacent to rad metrological and went into the cafe as well and overwhelming a concern that the staffing levels were not where we were and people are maxed out doing student work that the clarifications were doing having an impact on the stress levels of the work but also on the level of care the quality of care as a city and department of public health we want to make sure we can be as strong face to face we can especially, when they are opening up the new premium general hospital call up barbara hale and share with us the presentation and i think there is going to be 3 parts.

>> 2 parts. >> so thank you supervisor avalos to you directly thank you very much for keeping track of us and marshall we came back with accountability and thank you to the president and the vice chair and all the supervisors i'm pleased to be here and present the departments health care reform is part of the deliver system and the hiring f that we've made to provide the best possible patient care to san franciscans today is a joint font the unions i've been meeting with the unions they've worked with us closely we heard them and trying to respond the best we can to improve our process for hiring the health department is helping

with the necessary hiring improvements to serve our patient in our san francisco health network one year ago we laid out hiring process and taken the steps in insuring results in debt in today's presentation i'll talk about the ac a and our human resources decoration and dph representative. >> director garcia before you start i was in some confusion perhaps where the dups is a current affordable health care act provided and one is medi-cal expansion there is our largest footprint and the other coverage california for the last two

years that'stions program through the public california and for the last two years we've benefit in negotiation providers in san francisco the chinese community heartbeat plan we've been in negotiations to provide for a contract we're still in negotiation the target population is about three to four thousand but medicaid it the largest population we have enrolled over hocking thousand individuals. >> for medicaid. >> ac a is the law of the land you have the medicaid and insurance expansion and covered california is an component of that. >> accident framework to become. >> within the next couple of months we're no negotiations now for the first negotiation had to

tend end because of the enrollment time and started up to have a completion of the negotiations. >> great 3 parts to the ac a the medicaid and cover california all and, of course our own healthy san francisco to note that many communities around the country and the biggest health systems and los angeles is work the past leadership to begin another healthy la so to speak but we have almost 18 thousand people in the healthy san francisco for those who don't qualify for the ac a and left that open for the individuals in san francisco to be able to afford the covered california. >> in colonel 4 million people enrolled a 50 percent reduction

in california and in san francisco we did an enforcement effort with human services agency doing enrollment efforts in san francisco we saw over 54 percent reduction in insured 41 enrolled in covered cool and others in medi-cal and healthy san francisco was a universal health care system and we had a runway for healthy san francisco we were able to get people into healthy medical holmes and we transitions over many to meld and that meant they automatically were enrolled with a special program called sf path a reduction of 50 percent that of natural because most people

got enrolled in medi-cal and covered cal california. >> as you can see the enrollment over the last 2 years we've reorganized and spoke about this we've created the san francisco network n that networked is the combination of reorganizing our thousands being a stronger system of care and it is funded structure and during the first year of the implementation we enrolled increased the number of managed medi-cal patients within the system all the systems also in our community were part of healthy san francisco and were part of ac a we've expanded to over 29 thousand almost thirty thousand as of january with medi-cal partied and also we're targeting for the potential

eligible in our program right now to 4 thousand patients for immortal once we get the contract to look at the target population is our medi-cal population and it is higher telethon the natural transition for many of the san francisco patients. >> so we've actually, if i look at this chart a correlation for people that 2k3ishd enrollment healthy san francisco more people are in healthy san francisco. >> prior to ac a with the new changes for single individuals in protect we are on medi-cal you had to be disabled or more woman that had children. >> thank you. >> so health reform readiness

is an important of the strategic investment last year as you recall to bring us to into balanced budget we've provided a large amount of dollars 0 for the access under the affordable care act to reduce the use of hospitalizations and part of our goal to really decrease the waste time for primary care and down the avenue we're ready to open within the next year a new san francisco general and part of our key priorities for us is our investment in information technology this is going to be a chief process you'll hear about in this year's budget in terms of how to implement our electronic health record present prosecute or presently we have

electronic records and make sure that our care and quality are increased. >> kind of a guiding principle if we are looking at those 30 components that are part of overall approach covered california and healthy san francisco and medi-cal. >> uh-huh. >> a person that is a patient or a client anyone of those areas are they going to experience the exact level of care and benefits how does that work. >> we have a standardized level of care you'll be treated in the same manner the benefit for us may be different but for the patient they don't have a tier system of care depending on the revenue. >> thank you. >> so hiring for us really needs to focus on the top priorities to meet our patient

care goals as well as our financial we've had the significant growth in the positions in fiscal year 2018 and 2015-2016 budget as you can see we are hiring to fill a large number of new positions in addition to the agency that requires capacity the process improvements we're looking for a total of 2 year budget to increase the san francisco general number of vacancies hundred 50 and primary care about 29 this didn't include the rest of the department we have over 8 thousand in the department we have attrition a type of of the vacancy we have and the position which require a different approach to our hiring you'll hear hear about that in the process as we see improve

including the fact our human resources we've doubted their staffing to make sure we meet the ongoing need so the infrastructure had to be approached in the hiring issue. >> i'll leave it there for our human resources department ron to really respond to detailed our goals from the 2014 budget but any additional questions if you like to i couldn't i'll be happy to. >> thank you for presentation thank you. >> thank you. >> good afternoon. i'm ron the human resources director for publicity i was here a year ago and gave a presentation similar to this i want to let you know

we've followed up on items to better track our hire and supervisors are informed and monitor the process we implemented 5 event one in audubon society august of 2014 and that was at that time, we find the nurses hiring was average hundred and 93 days and we wanted to knock that down our goal to reduce temporary employees we've developed mayor's office of housing and economic development matrix weekly reports in the tunsz improvement part we've partnered with not only the dui department of home sharing and the lean in august the controller's office was there and union representation we had county representative and continued that model i'm going to turn it

over to briefly to the department of human resources and ted will explain about the partnership thank you ron arrest supervisors good afternoon. i'm ted the manager deputy director about a year ago mickey the home sharing director asked me to work with the department of public health and to identify and address the amount of time to hire a re7b8d nurse at san francisco general the partnership was established between dph and h.r. the work of the aspirin began with a thorough and holistic approach to identify all the steps it takes to hire a registered nurse from the point of vacancy to the nurses first day on the job we identified what steps and who was doing that work and how long that was taking and importantly what that

work valuable in hire a registered nurse and placing that individual in a position we discovered that there are so many processes in the system that are merged by stakeholder westbound the dph and the mayor's office of budget we identified on average where an hundred and 90 to 2 hundred days to hire a hire a nurse that was anecdotal true it takes too long the good thing about the data it serves as a post we could attache case attack what we needed to implement in a efficient process based on the data director callahan helped us to develop a process but maintained our core values of merit based hire some of the

successful hiring the krument activity clearly if we developed a quick selection process unless we can target the candidate pool we recognized as a merit system under the civic rules documentation of progress and selection are necessary; however, the current process was paper intensive and another strategy to do you want a selection and communication to us this meant for the first time we're prioritizing the candidates in the selection process we wanted our new progress to be respect and the efforts to apply as well as mooefb updates to the candidates to they misunderstood would was expected and the timelines they had to deal with us in get thirty to that selection process

this transparent opened up the door and we heard about the process and all of a sudden no communication through the partnership and the labor partners we've got a new hire we call it the pc p hiring process we believe that it can serve as a model for other clarifications citywide that maybe experiencing hiring details one of the key components we accept applications and allow the candidates to an online on demand process we we implemented an e electronic for current nurses working in dph for the same class a repositioning that was manual and paper intensive and eliminated all process steps

that caused details and we believe the selection steps were important were met simultaneously to the extent possible expedite the process we better defined the nursing role with the flexibility and discretion they needed under the civic service rules to select the most qualify for the position we've provided hiring books and on demand videos to make sure our efficiency is sustainable about again, it was designed to increase the effectiveness and to reduce the hiring timelines from hundred 90 today's to 40 days and ron will provide you with hiring timeline data we've received from the

duplicate and it indicates we've been successful or made significant improvements in reducing the hiring time more importantly we believe we've delivered a comprehensive hiring program. >> the pcc p was launched in april of last month. >> the way we launched it many components are take place in order for the hiring manager to have eligible folks interested in the position we launched it now for the first phase with dph was to insure people were provided with information submitting 0 online on the documents we needed at the end of the process causing delays and provided a milestone maker so the process includes the following steps and the

timelines to include the steps that led to the companionships of eligibility and the civil service rules to see if they're interested in a position that process is happening as we speak the first real access to eligible candidates in positions will happen later this week to the hiring manages to start. >> thank you when i visited the hospitals a lot of the nurses talked about how long it takes in the past that many nurses decide to not work for the city but elsewhere i'm wondering if there was a look at others dph systems in the private or the non public sector that helped to put together this plan and how do you see comparing to what is

happening to people discussing to stay have we eliminated those barriers. >> supervisors we've attempted to eliminate as many barriers as possible we're within the civil service constraint ware merit based so we attempted to eliminate all of the hurdles that caused the details in the selection process major focus of this program is really providing the hiring managers with discretion and flexibility to make the hiring decision to identify people that are best qualified for the position under the old system supervisor a tremendous amount of rigidity in how much flexibility a hiring manage would go under the referral if the hiring manager was unable to make a hiring discussion we at

human resources had to back out of the positions tied to the referral in order to give the hiring manager flexibility we tried to do all the work up front in h.r. and better dining room the hiring managers have an obligation to identify individuals that are best suited for the job they 14 interview the people in h.r. we want to make sure the data that the hiring manager has access to the materials at the their fingertips there are significant details in the selection processed we're waiting for documents to get mailed or sent in and sow we were detailing what the hiring managers told us the opportunity to express interest in a key candidate we've heard again and again the manager has a candidate in their greatest i think the process

will take oath 3 and a half months we want you to stay with us we eliminated those that opportunities if we do our jobs right in h.r. the eligible list of interested qualified people will be available for managers to hire. >> great, thank you. >> so the goal back in august of 2014 was to start those lean improvement yipz with the idea of providing better service to the hiring managers and to serve the public as our mandate so this meant we wanted to reduce the time to hire as ted said from hundred 90s days we've taken a snapshot for each month in the beginning of 2014 and gone from hundred